Silverstein M D, Albert D A, Hadler N M, Ropes M W
Department of Medicine, University of Chicago, IL 60637.
J Clin Epidemiol. 1988;41(7):623-33. doi: 10.1016/0895-4356(88)90114-x.
A Markov model of prognosis was evaluated by comparing the duration of disease activity states and life expectancy with Kaplan-Meier survival curves for 98 patients with systemic lupus erythematosus with 1080 patient-years of observation. A four state (remission, active, flare and death) homogeneous Markov chain was constructed to determine the transition probabilities between disease states, the probability of disease states over the subsequent 25 years, time in each disease state, and life expectancy. Approximately 85% of the clinical course of patients was in the active disease state; no patient made a transition directly between remission and flare; virtually all deaths occurred from the flare disease state. The proportion of the patient population in each disease state over time provided a convenient graphic summary of the natural history of SLE that supplemented the Kaplan-Meier survival curves. A Markov model analysis yields a clinically useful description of outcome for multistate diseases that supplements survival curves.
通过将98例系统性红斑狼疮患者疾病活动状态的持续时间和预期寿命与Kaplan-Meier生存曲线进行比较，并进行1080患者年的观察，对一种预后的马尔可夫模型进行了评估。构建了一个四状态（缓解、活动、复发和死亡）齐次马尔可夫链，以确定疾病状态之间的转移概率、随后25年疾病状态的概率、每个疾病状态的时间以及预期寿命。患者临床病程约85%处于疾病活动状态；没有患者在缓解和复发之间直接转换；几乎所有死亡都发生在疾病复发状态。随着时间推移，处于每种疾病状态的患者人群比例提供了系统性红斑狼疮自然史的便捷图形总结，补充了Kaplan-Meier生存曲线。马尔可夫模型分析为多状态疾病的结局提供了一种临床有用的描述，补充了生存曲线。
